Rev Bras Med Esporte vol.12 número1 en v12n1a01

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Rev Bras M ed Esporte _ Vol. 12, Nº 1 – Jan/Fev, 2006

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1. M inas Gerais Federal University.

2. M inas Gerais Pontifical Catholic University.

Received in 25/1/05. Final version received in 16/8/05. Approved in 5/9/05. Correspondence to: Rodrigo Nogueira Ribeiro, Rua Courupita, 1.557, apto. 101, Eldorado – 32310-520 – Contagem, M G, Brazil. Phone: (31) 3391-3467/(31) 9142-7258. E-mail: rodrigonog@hotmail.com

Epidemiologic analysis of injuries occurred

during the 15

th

_{Brazilian Indoor Soccer (Futsal)}

Sub20 Team Selection Championship

Rodrigo Nogueira Ribeiro1_{and Leonardo Oliveira Pena Costa}2

O

RIGINAL

A

RTICLE

Keyw ords: Indoor soccer. Futsal. Outdoor soccer. Injury. Incidence rate. Tournament.

ENGLISH VERSION

ABSTRACT

Introduction: Several authors have investigated the incidence

of injuries occurred in the outdoor soccer game. How ever, there are only few w orks analyzing injuries occurred in the indoor soc-cer game (futsal). The purpose of this study w as to analyze the incidence, circumstances, and characteristics of injuries recorded in the indoor soccer during the 15th_{Brazilian Sub20 Futsal}

Cham-pionship. M ethods: Physiotherapists and doctors of every team

selection participating in the 15th_{Brazilian Sub20 Futsal}

Champi-onship answ ered a questionnaire w ith the purpose to investigate the occurrence of injuries during the games. The answ ering rate w as 100% . Results: 32 total injuries w ere recorded along 23

games, w ith a 1.39 injury incidence per game, or 208.6 injuries per 1,000/game. Approximately 1 to 3 injuries per game resulted in removal of players from gaming or training. Contact injuries w ere predominant in 65.62% (21 out of 32 injuries), and most of these injuries did not result in removal of the players. Conclusions: The

present study observed that the injury incidence during the 15th

Brazilian Sub20 Futsal Championship w as similar to the incidence during the Indoor Soccer tournaments, but higher than those found in the outdoor soccer tournaments, characterizing the specificity of the sports. Nevertheless, circumstances and characteristics are similar among them, mainly due to the similar demand of the sports.

INTRODUCTION

Indoor Soccer is an ascending sport that has attracted more and more follow ers all over the w orld. In Brazil, it is one of the most spread sport, played by more than tw elve million Brazilian people, according to the Futsal Brazilian Confederation (CBFS)(1)_.

Keller et al.(2)_{assert that the soccer game is responsible by the}

highest number of sportive injuries in the w orld. It is estimated that these injuries are responsible by 50 to 60% of the sportive injuries in Europe, and 3.5 to 10% of the physical traumas treated in the European hospitals are caused by the soccer game(2-4)_.

Several studies have analyzed the incidence and risk factors for injuries in the soccer game(4-22)_{, but there are few articles}

discuss-ing the indoor soccer(3,23,24)_{, and only one study comprising the}

Indoor Soccer(13)_{. According to Junge et al.}(13)_{in a study performed}

during the International Soccer Federation (FIFA), and in the 1998 and 2001 Olympic Games, it w as observed a 191 injury incidence per 1,000 gaming hours in the 2000 Guatemala World Champion-ship of Indoor Soccer, an approximately tw o times higher rate found

by them in the outdoor soccer tournaments (92 injuries per 1,000 game hours).

Such difference can be attributed to the nature of the game, associated to the high speed of the movement, the low er size of the court, and differences on the floor, resulting in a higher amount of collisions and sprains, respectively(13)_{. Added to the ow n}

char-acteristics of the sport, the Indoor Soccer is one of the most prac-ticed sportive modalities in the w orld, and this fact requires sys-tematic investigations as to the incidence of injuries.

Definition of the injury

Several epidemiologic studies define differently the term sport-ive injuries, thus making difficult to make a comparison betw een these studies(2,11,23,25-28)_{. Some studies define injuries as those}

treat-ed by the mtreat-edical department and requiring hospitalization(8)_{. These}

sportive injuries w ere recorded in the insurance policy, and it w as observed that the higher percentage among them w as severe, and predominantly acute. Besides, low severity injuries or those caused by the overuse w ere not recorded, and this w as called the “ iceberg peak phenomenon”(28)_.

M ore recent studies have defined the injury as an event that w ould have as consequence the player being removed for a given period of time from the games or trainings(9,17,24,29,32)_{. According to}

Junge and Dvorak(11)_{, such definition is not completely accurate.}

First, its application depends on the training and gaming frequen-cy. Second, injured athletes can have a moderate participation in the trainings through a change in their exercising program. Third, the participation in the training and games depends on other fac-tors, such as availability of an adequate treatment and importance of the game.

The National Athletic Injuries Recording System in the United States (NAIRS) defines injury as an event that limits the athlete to participate in games or in the training for at least one day after the occurrence. This definition is more accurate, but it also does not solve all the aforementioned difficulties(28)_.

The definition of the European Council requires that the injury has at least one of the follow ing consequences: 1) reduction in the amount or level of the sportive activity; 2) it requires medical assessment or treatment; 3) it has unfavorable social and eco-nomic effects. This present definition for the injury seems to be more comprising, but it has been less used(9,20)_.

Besides the definition of the sportive injury, another point that deserves to be mentioned is to define the severity of the injury. The severity of the injury has been defined by the endurance of the removal from the sportive practicing, and it is classified in three categories: mild (1 to 7 days), moderate (8 to 21 days), and severe (more than 21 removal days)(17,30-32)_{. Van M echelen et al.}(28)

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Ladeira(15)_{asserts that the epidemiologic}

studies are the first step to elaborate a pre-ventive program. Physicians, therapists and physical educators must understand the incidence, risk factors and the mechanisms of the injury, in order to be able to combat its causes(2,33)_{. The authors of this article are}

not aw are of epidemiologic studies on inju-ries occurred in Indoor Soccer in Brazil prac-titioners.

The purpose of this study w as to make a prospective analysis on the incidence, cir-cumstances and characteristics of the inju-ries occurred in the Indoor Soccer record-ed during the 15th_{Brazilian Sub20 Selection}

Championship.

M ETHODS

The study w as performed during the 15th

Brazilian Sub20 Team Selection Champion-ship, a tournament organized by the CBFS. It w as studied one hundred and eighty 17 to 20 years old athletes representing ten State team selections.

Physicians, therapists or physical coach-es of ten participating team selections an-sw ered a form (figure 1) w ith the purpose to investigate the occurrence of injuries occurred during the games. That form w as adapted from a medical record performed by FIFA: M edical Assessment and Research Center (F-M arc)(13)_{. Whenever a player has}

been injured, the details of his life w ere re-corded through an interview conducted by the main author of this research. After the end of the tournament, the author had reg-ular telephone conversations to physiother-apists, coaches and/or athletes, in order to make a follow -up of the injuries’ evolution. In this study, an injury w as defined as any commitment occurred during a game, re-gardless its consequences related to the subsequent rem oval from the gam es or training(13)_{. The injuries w ere recorded based}

on their circumstance (w ith or w ithout con-tact), location, type and severity, and these data are presented on table 1. In this study, all data w ere descriptively presented.

This study w as approved by the ethics committee of the M inas Gerais Pontifical Catholic University and the Arbitration Coun-cil of the 15th_{Brazilian Sub20 Team}

Selec-tion Championship, and all volunteers par-ticipating in this study gave their consent to such participation.

Calculation of the incidence

The incidence for injuries w as expressed as the amount of injuries per game and the amount of injuries per 1,000 gaming hours per athlete, according to prior studies(12,13)_.

The amount of gaming hours per athlete w as calculated according to the follow ing equation: 10 players x 40 minutes = 6.67 hours. The extra time and the reduction in the amount of athletes playing during the

Recorded injuries during the 15

th

_{Brazilian of the}

Sub20 Team Selection Championship, São Paulo, 2004

Team:___________________________________Game:______________ x ________________ Date: ___/___/___

Name of the responsible physician, physiotherapist or physical coach: _____________________________________

Phone/fax:__________________________________ E-mail:________________________________________________

Please inform:

Every injury (overuse or trauma) occurred during the game, regardless its consequence related to the conse-quent removal from the game or training. Information reported w ill be used in medical researches, and it w ill be handled as confidential.

Athlete Location Diagnosis Severity Circumstance

No.

Site of Code Type of Code Removal time With Without

the injury the injury (days) contact contact

___________________________________________________________________________________________________

There w as no injury during the game ____

For the definition of the site and severity of injuries see back page.

Code to the site, type, and severity of the injuries

Location of the injury Type of the Injury Trunk

01. Head and face 01. Chock w ith loss of consciousness 02. Columna cervicalis 02. Chock w ithout loss of consciousness 03. Columna thoracic 03. Ligamentous injury w ith instability 04. Columna lumbar 04. Ligamentous injury w ithout instability 05. Thorax 05. Injury in the meniscus

06. Abdomen 06. Fracture

07. Pelvis/sac 07. Luxation/subluxation

Upper End 08. M uscular strain

08. Shoulder 09. Sprain

09. Arm 10. Contusion

10. Elbow 11. Excoriation 11. Forearm 12. Lombalgia/cervicalgia 12. Wrist 13. M uscular fatigue

13. Hand 14. Bursitis

14. Finger 15. Tendinitis/tendinosis 15. Thumb 16. Cortocontusion

Low er End 17. Others

16. Hip

17. Groin Severity of the injuries days

18. Thigh 0 = 0 days

19. Knee 1 = 1 day

20. Leg 2 = 2 days

21. Ankle 7 = 1 w eek 22. Feet 14 = 2 w eeks

23. Finger > 30 = more than 4 w eeks

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games w ere not considered, since none of the games required an extra time, and the exclusion of athletes w as a rare event that lasted a short-time.

RESULTS

A total of 32 injuries w ere recorded during the 15th_Brazilian

Sub20 Team Selection Championship, w ith a 1.39 injuries/game incidence. The circumstances for the injuries w ere recorded by the occurrence or not of contact (direct or indirect trauma). The injuries w ith contact w ere predominant, w ith a 65.62% (21 out of 32 injuries) rate, and the major part of these injuries did not result in removal of athletes from the sportive activities. Complementa-ry information on the incidence, circumstance, and characteristic of the injuries are found on table 1.

sulted in removal of athletes from the sportive activities than con-tact injuries (65.62% ; 21 out of 32 injuries). The severity (removal time) w as higher for injuries w ithout contact compared to injuries w ith contact (see details on table 2).

DISCUSSION

This study investigated the incidence and characteristics of in-juries during the 15th_{Brazilian Sub20 Team Selection}

Champion-ship. All the ten team selections participating in the tournament cooperated in this study answ ering an adapted F-M ARC(13)

ques-tionnaire after the games, resulting in a 100% answ ering index. In this study, the injuries w ere defined as any commitment occurred during the games regardless its consequences as to the conse-quent removal from the games or training(13)_.

The use of a w ide definition including “ every injury (overuse and trauma) caused during the soccer game, regardless its conse-quence” avoids any problems associated to other restricted defi-nitions(13)_{. It allow s the assessment of chronic injuries through the}

assessment of the impact caused by the high incidence rate of mild and moderate contusions compared to fractures, for instance. Besides of making available additional information (such as cal-culation of the length of time of the removal from the activity and treatment performed by a physician or therapist), allow ing to ex-press the incidence of injuries according to different definitions, thus allow ing to make a comparison of the results related to other studies.

Another important factor is that such w ider definition makes possible to minimize errors occurred during the data collection that is performed by different examiners from several professions (physicians, physiotherapists, physical educators, etc.) w hat might be one of the limiting factor to this type of study.

Several studies have demonstrated a great difference in the incidence rates of injuries recorded in the soccer game(2,11,23,25-28)_.

Junge and Dvorak(11)_{have attributed these differences to}

hetero-geneous definitions, data collection methods, time of observation, type of the study, and characteristics of the sampling found in the w orks.

The definition of the injury as w ell as its severity are important aspects w hen recording sportive injuries, and they have been dis-cussed by several authors(2,11,23,27,28)_{. Junge and Dvorak}(11)_assert

that the definition of the injury must be based on the prevalence of the appropriate complaint to the soccer game, and the severity is not determined only by the endurance of the symptoms, but also by the damaged tissue, since small injuries and those “ healed” using analgesia or medication are neglected, and the incidence rate of injuries may be underestimated.

The data collection system has also been aim for several dis-cussions. Liendefeld et al.(3)_{assert that the adequate recording}

system must include components such as location, type and cir-cumstance of the injury.

Junge and Dvorak(11)_{recommend that the exact calculation of}

the incidence of the injuries, as w ell as the amount of the game and training must be individually documented for each athlete. Besides, they assert that record of the sportive injury must be performed prospectively, since retrospective data have a limited value, and the prospective studies besides of assessing the inci-dence of injuries, can also identify the groups and risk factors.

In the present study, the incidence of injuries (208.6 injuries/1,000 game hours) w as slightly higher than the incidence recorded by Junge et al.(13)_{during the 2000 Guatemala World of Indoor Soccer}

Championship (191 injuries/1,000 game hours). Such higher inci-dence may be explained by a technical and tactic fragility, as w ell as a low er muscular strength, resistance, coordination and skill found in young athletes. M odifications in the training system for young athletes, aiming the technique, ability, as w ell as the physical condi-tioning can minimize the incidence of sportive injuries(19)_.

TABLE 1

Incidence and characteristics of injuries

Number of games 023

Answ ering index 023 (100% ) Number of recorded hours 153.4 Number of injuries 032 Injuries per game 001.39 Injuries per 1,000 hours 208.6

Circumstance

With contact 21 (65.62% )

Without contact 11 (34.38% )

Time of the removal

0 day 21 (65.62% )

1 day 05 (15.62% )

4 days 01 (3.13% )

> 1 w eek < 1 month 04 (12.5% ) > 1 month 01 (3.13% )

Injuries w ith removal 11 (34.38% )

Injuries per game 00.48 Injuries per 1,000 hours 71.7

Injured part of the body

Head, face, neck 01 (3.13% ) Upper end, including shoulder 01 (3.13% )

Trunk 03 (9.37% )

Thigh 09 (28.12% )

Knee 04 (12.5% )

Ankle 08 (25% )

Ankle 06 (18.75% )

Type of injury

Sprain 09 (28.12% )

Contusion 10 (31.25% )

Fracture 01 (3.13% )

M uscular strain 03 (9.37% ) Ligamentous injury w ith instability 01 (3.13% ) Tendinopathy 04 (12.5% ) M uscular fatigue 02 (6.25% ) Lombalgia/cervicalgia 03 (9.37% )

Others 01 (3.13% )

TABLE 2

Time of removal related to injuries w ith and w ithout contact

Time of removal Injuries w ithout contact Injuries w ith contact

(n = 11) (n = 21)

n (%) n (%)

With no removal 6 (55% ) 15 (71% )

1-3 days 2 (18% ) 03 (14% )

4-7 days 0 0(0% ) 01 0(5% )

7-28 days 2 (18% ) 02 (10% )

> 28 days 1 0(9% ) 00 0(0% )

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It w as not possible to assess injuries during the training, since in short tournaments like that, teams play daily games, and in the majority of cases, this makes unviable to train betw een competi-tions, and thus, our w ork w as limited to assess only the incidence of injuries/gaming hours.

The incidence rate of injuries w ithout contact w as higher than the rates found in other tournaments(13)_{, and 45% of these injuries}

resulted in removal from the games or training. Such high inci-dence rate of injuries w ithout contact may be an indicator that athletes had not time enough to prepare themselves to all the tournament’s demand, and/or there w as no available recovering time from injuries along the competition.

The major part of the injuries (65.62% ) w as caused by direct contact, and the contusions and sprains w ere the most common type of injury along the tournament, and this result w as similar to other studies(3,12,23,24)_{. We found a slightly higher sprain rate than}

those recorded by Junge et al.(12,13)_{in the 1998 and 2002 FIFA’s}

soccer tournaments, as w ell as in the 2000 Olympic Games. This difference may be attributed to the rubber and more adherent floor of the Indoor Soccer’s court, compared to the outdoor soccer’s grass that predisposes athletes to a higher amount of sprains.

The location of the recorded injuries w as similar to the ones found in other studies(3,4,10,12,13,15-17,19,21-23)_{, predominantly affecting}

the ankle and knee’s joints, and the thigh and leg’s muscles. The disproportion betw een body’s parts may be attributed to the high-er demand imposed to the low high-er end in that sport(19)_.

CONCLUSION

The present study observed that the incidence, circumstance, and characteristics of the injuries occurred during the 15th

Brazil-ian Sub20 Team Selections Championship are similar to those ver-ified both in Indoor and outdoor soccer tournaments, characteriz-ing the specificity of the sport. The analysis on the incidence and risk factors related to sportive injuries, as w ell as preventive pro-gram development are extremely important aiming to reduce inju-ries w hile practicing the sport.

THANKFULNESS

The authors w ish to thank the cooperation of every physiotherapist and physical coaches of the delegations (Espírito Santo, M aranhão, M ato Gros-so do Sul, M inas Gerais, Paraná, Pernambuco, Rio de Janeiro, Santa Cata-rina, São Paulo, Tocantins) that voluntarily disposed their time to the data collection for the accomplishment of this w ork. We w ould like to express our gratitude to every athlete w ho participated in this study.

All the authors declared there is not any potential conflict of inter-ests regarding this article.

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